Why the Trump Era Could Spell Regulatory Rollbacks for Home Health

With the outcome of the nation’s presidential election put to bed, the new administration rolling into the nation’s capital affords opportunities for many industries. One key campaign promise of President-elect Donald Trump to cut regulations could spell good news for the home health care and hospice industries, which have faced an onslaught of new requirements over the past several years.

From the Pre-claim Review Demonstration from the Centers for Medicare & Medicaid Services (CMS) to the elimination of the overtime exemption rule, the home health and home care industry has seen major changes that have impacted the way businesses run.

Leaders from the National Association for Home Care & Hospice (NAHC) are eyeing big opportunities to roll back burdensome regulations with the incoming administration and new members of Congress, they said during a teleconference this week on the impact of the election results. At the same time, the industry group is weighing the risks of overturning some of the biggest reforms to the health care system.

Regulatory Rollback Opportunities

“There’s a great opportunity to revisit a number of rules,” Bill Dombi, NAHC’s vice president for law, said during the web event Tuesday. “At the top our list is the face-to-face requirements, along with the pre-claim review action that came out of CMS.”

NAHC has already indicated it will move forward with a lawsuit to challenge the pre-claim review demonstration in Illinois and the four other states it will likely be implemented in. The group is “bullish” on its ability to work with the new administration and Republican majority in Congress to push back against the program.

In regards to the face-to-face requirements, NAHC is seeking rollbacks on the documentation process and has long supported legislation that would enable nurse practitioners to sign off on home health care plans in addition to physicians.

“Why we see great opportunity with the new Congress and administration [is because] we have strong Republican support for a legislative effort to modify the regulatory elements,” Dombi said. “With a new CMS administration, Health and Human Services (HHS) secretary, and others, we hope we can get them to back off the onerous documentation requirements.”

However, the changes are not likely to happen overnight.

“I myself am optimistic,” Dombi said. “Let me temper that with the nearly 5,000 jobs that President-elect Trump has to fill in agencies from secretaries on down. The turnover on leadership will make the changes not happen right away.”

Fortunately, some potential candidates being considered for administrative positions are already allies of NAHC, and executives said they could be “smiling” at some of the opportunities to work with new leadership in the health care agencies.

The Risk of Repeal

With all the opportunities, there are still many unknowns. One of the most significant campaign promises from President-elect Trump was to repeal and replace the Affordable Care Act (ACA). Republicans in both houses of Congress have similarly put forth great effort to overturn the heath care reform law, with at least 52 tries to repeal it, in part or in full.

Yet, repealing the ACA in full leaves the health insurance of 20 million Americans who have signed up for coverage under the new reforms up in the air. Neither Republicans nor Donald Trump have put forth an “adequate” replacement plan that would account for those 20 million Americans’ coverage, according to Prue Fitzpatrick, vice president for government affairs at NAHC.

“It will will be interesting to see how a campaign slogan translates into actually governing without taking health care away from 20 million Americans,” Fitzpatrick said during the panel discussion. “It’s difficult [to repeal] since the ACA and health care system at large has so many components to it.”

The best health care plan to analyze in terms of what might replace the ACA is Paul Ryan’s “Better Way” plan, NAHC executives say. Yet even that plan doesn’t provide a complete explanation for those currently covered under ACA insurance offerings.

In the last week since the election, Donald Trump also appears to be “softening” about his position of repealing the ACA. During a recent interview with CBS’ 60 Minutes, Trump explained that he would be open to keeping certain parts of the health care law, including keeping young people on their parents’ insurance plans until the age of 26 and requiring insurance companies not turn away those with pre-existing conditions.

Furthermore, general concepts of the ACA, like shifting the health care system away from fee-for-service toward value-based purchasing, are likely to remain in place. Home health, as a setting with a lower cost of care, stands to benefit from this shift.

Furthermore, the process of repealing the law in the Senate could prove difficult, with Republicans only having secured 52 seats in their majority. To sweep the Senate, the party would need a 60-vote majority. Though, there are steps the Republicans could take to undo the ACA in the Senate.

Repealing parts of the ACA that are more broadly supported, including the employer mandate that require businesses of a certain size to offer health insurance coverage to employees, are supported by NAHC. Dismantling that requirement would benefit NAHC’s home care, home health and hospice members, leaders said Tuesday.

Looking ahead, NAHC is ready to act on the regulatory opportunities with the new administration and leadership across governmental agencies.

“No matter what anyone’s position is, step back and look at the tremendous opportunity on the regulatory side and industry side,” said Fitzpatrick. “It doesn’t mater what party is in power, there are a lot of good minds in Washington looking to lower cost of care and looking at quality of outcomes.”